Predictive Factors of Worsening of Esophageal Varices After Balloon-Occluded Retrograde Transvenous Obliteration in Patients With Gastric Varices

Elsamman, Mahmoud Kamal; Fujiwara, Yasuhiro; Kameda, Natsuhiko; Okazaki, Hirotoshi; Tanigawa, Tetsuya; Shiba, Masatsugu; Tominaga, Kazunari; Watanabe, Toshio; Oshitani, Nobuhide; Arafa, Usama Ahmed; El-Sayed, Ahmed A.; Nakamura, Kenji; Arakawa, Tetsuo

doi:10.1038/ajg.2008.140

Cited by 21 publications

(28 citation statements)

References 44 publications

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“…Deterioration of EV due to increased PVP after B-RTO is a major issue in the long-term management of these patients. 18,19 Starting in 2005, we performed concomitant PSE in some patients undergoing B-RTO to lower the PVP by decreasing the splenic venous flow. We measured the shunt venous pressure as a surrogate measure of PVP in patients who underwent combined therapy and found that the elevation in the shunt venous pressure due to temporary occlusion of the gastrorenal drainage vein with a balloon was diminished.…”

Section: Discussionmentioning

confidence: 99%

“…15 The reported rate of GV rebleeding is significantly lower after B-RTO than after TIPS placement 16 or endoscopic intervention, 17 but B-RTO results in increased portal venous pressure (PVP), which may cause enlargement of EVs. 18,19 We previously reported on the efficacy and safety of simultaneous combined B-RTO and partial splenic embolization (PSE) for GVs 20 based on the hypothesis that concomitant PSE can diminish the increase in PVP after B-RTO. After experiencing more cases and performing longer-term follow-up, we re-evaluated the efficacy of simultaneous combined B-RTO and PSE for GVs in the management of portal hypertension with respect to preventing EV exacerbation.…”

Section: Introductionmentioning

confidence: 99%

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Simultaneous combined balloon‐occluded retrograde transvenous obliteration and partial splenic embolization for gastric fundal varices

et al. 2016

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Background: We previously reported the techniques and usefulness of simultaneous combined balloon-occluded retrograde transvenous obliteration (B-RTO) and partial splenic embolization (PSE), based on the hypothesis that concomitant PSE can diminish the increase in portal venous pressure after B-RTO. Objective: After experiencing more cases and performing longer-term follow-up, we re-evaluated the efficacy of simultaneous combined B-RTO and PSE for gastric fundal varices (GVs). Methods: We performed B-RTO in 36 consecutive patients treated for GVs from 2005 to 2013. Twenty-three patients underwent simultaneous combined B-RTO and PSE (Group 1) and 13 underwent B-RTO monotherapy (Group 2). The outcomes were retrospectively evaluated. Results: There were no significant differences in baseline characteristics between the two groups except that the splenic volumes were larger in Group 1 than 2. B-RTO was technically successful in 21 of 23 patients (91.3%) in Group 1 and in 12 of 13 patients (92.3%) in Group 2. In all patients with ruptured GVs (six in Group 1 and five in Group 2), complete hemostasis was obtained by B-RTO. Exacerbation of esophageal varices was significantly less frequent in Group 1 than 2 (p ¼ 0.0017). Conclusion: Concomitant PSE with B-RTO may contribute to prevention of the exacerbation of esophageal varices after B-RTO.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Simultaneous combined balloon‐occluded retrograde transvenous obliteration and partial splenic embolization for gastric fundal varices

et al. 2016

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“…However, worsening of EV and possible ascites due to portal hypertension after B-RTO are problems. Reportedly, the aggravation rate of EV was 27 % in the first year [9] and 66–67 % cumulatively [9, 11, 12]. Endoscopic examination for EV in cirrhotic patients has been recommended every 1–2 years [3].…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Aggravation of Esophageal Varices after B-RTO for Gastric Varices

Jogo

Nishida

Yamamoto

et al. 2013

Cardiovasc Intervent Radiol

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PurposeTo retrospectively evaluate risk factors for aggravation of esophageal varices (EV) within 1 year after balloon-occluded retrograde transvenous obliteration (B-RTO) of gastric varices (GV) and to clarify suitable timing for upper endoscopy to detect EV aggravation after B-RTO.MethodsParticipants included 67 patients who underwent B-RTO for GV between January 2006 and December 2010. Whether EV aggravation occurred within 1 year was evaluated, and the time interval from B-RTO to aggravation was calculated. Factors potentially associated with EV aggravation were analyzed.ResultsB-RTO was successfully performed in all patients. EV aggravation at 1 year after B-RTO was found in 38 patients (56.7 %). Multivariate logistic regression analysis showed that total bilirubin (T-bil) (P = 0.032) and hepatic venous pressure gradient (HVPG) (P = 0.011) were significant independent risk factors for EV aggravation after B-RTO. Cutoff values of T-bil and HVPG yielding maximal combined sensitivity and specificity for EV aggravation were 1.6 mg/dL and 13 mmHg, respectively. The patients with T-bil ≥ 1.6 mg/dL or HVPG ≥ 13 mmHg had a median aggravation time of 5.1 months. All five patients with ruptured EV belonged to this group. In contrast, patients with T-bil < 1.6 mg/dL and HVPG < 13 mmHg had a median aggravation time of 21 months.ConclusionT-bil and HVPG were significant independent risk factors for EV aggravation after B-RTO. The patients with T-bil ≥ 1.6 mg/dL or HVPG ≥ 13 mmHg require careful follow-up evaluation, including endoscopy.

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“…Gastric varices occur in 20∼30% of portal hypertension patients, and the highest incidence is seen among patients with Child-Turcotte-Pugh class B or C. 2 The management of gastric variceal hemorrhage consists of volume resuscitation, pharmacologic therapies (vasoactive agents), endoscopic therapies (ligation or sclerotherapy), mechanical therapies (SB tube, Minnesota tube etc), transjugular intrahepatic portosystemic shunt, and shunt surgery. 3 The SB tube is used to control upper gastrointestinal bleeding, especially variceal bleeding when endoscopic and/or pharmacologic treatment fails to control, or effective emergency hemostasis is needed.…”

Section: Discussionmentioning

confidence: 99%

Tracheoesophageal Fistula in the Treatment of Gastric Variceal Hemorrhage with Sengstaken-Blakemore Tube

Kim

Lee

et al. 2012

Korean J Helicobacter Up Gastrointest Res

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The Sengstaken-Blakemore tube (SB tube) is used to control esophageal or gastric variceal bleeding in emergencies, and various complications have been reported following its use. Tracheoesophageal fistula (TEF) is an extremely rare complication after SB tube insertion. We herein present a case of an 80-year-old female patient who experienced TEF after repeated insertion of the SB tube to control recurrent gastric variceal hemorrhage.

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Predictive Factors of Worsening of Esophageal Varices After Balloon-Occluded Retrograde Transvenous Obliteration in Patients With Gastric Varices

Abstract: The presence of EV, higher Child-Pugh class, and higher resistance index assessed by ECDUS before B-RTO were significant risk factors for worsening of EV after B-RTO.

Cited by 21 publications

References 44 publications

Simultaneous combined balloon‐occluded retrograde transvenous obliteration and partial splenic embolization for gastric fundal varices

Simultaneous combined balloon‐occluded retrograde transvenous obliteration and partial splenic embolization for gastric fundal varices

Factors Associated with Aggravation of Esophageal Varices after B-RTO for Gastric Varices

Tracheoesophageal Fistula in the Treatment of Gastric Variceal Hemorrhage with Sengstaken-Blakemore Tube

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